• Delaram Molkara, Shai Tejman-Yarden, Howaida El-Said, and John W Moore.
• Rady Children's Hospital-San Diego, Department of Pediatrics, University of California-San Diego, CA 92123, USA.
• Congenit Heart Dis. 2011 Sep 1; 6 (5): 461-5.

ObjectiveClassically pericardiocentesis has been described and performed through the subxiphiod approach, which is feasible if the pericardial fluid is circumferential or collected inferior or anterior to the heart. However, not uncommonly, the collection of fluid is at the base of the heart or in the posterior or apical portion of the pericardium, necessitating a different approach. The purpose of this study is to describe echo and fluoroscopic guided pericardiocentesis to evacuate noncircumferential effusions, which are not accessible from the standard subcostal approach.MethodsRetrospective review of all patients with localized/noncircumferential effusions at Rady Children's Hospital San Diego between May 2007 and February 2010 was performed. During these procedures, effusions were identified at the point closest to the skin. The pericardial drains were introduced, directed, and advanced under echocardiographic and fluoroscopic guidance while avoiding major organs.ResultsTen patients were identified (age ranged from 20 days to 22 years, weight ranged from 1.6 kg to 94 kg). All procedures were successful in draining the pericardial effusions with minimal residual fluid and no complications.ConclusionEchocardiographic and fluoroscopic guided pericardiocentesis is a feasible, relatively safe, and reliable technique to drain loculated pericardial effusions using nonstandard entry sites.© 2011 Copyright the Authors. Congenital Heart Disease © 2011 Wiley Periodicals, Inc.

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